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Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi

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To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. Methods As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Results Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding. Conclusion Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.

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Published 01 January 2006
Reads 16
Language English
International Breastfeeding Journal
BioMedCentral
Open Access Research Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi 1 22 Ellen G Piwoz*, Yvonne Owens Ferguson, Margaret E Bentley, 2 33 4 Amy L Corneli, Agnes Moses, Jacqueline Nkhoma, Beth Carlton Tohill, 5 44 Beatrice Mtimuni, Yusuf Ahmed, Denise J Jamieson, Charles van der 2 6 Horst ,Peter Kazembeand the UNC Project BAN Study Team
1 2 Address: Academyfor Educational Development, 1875 Connecticut Ave, NW, Washington, DC, 20009, USA,University of North Carolina at 3 4 Chapel Hill, 1700 Airport Road, CB# 3368 Chapel Hill, North Carolina, 27514, USA,UNC Project, Private Bag A106, Lilongwe, Malawi,US 5 Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, Georgia, 30333, USA,Bunda College of Agriculture, Bunda, Malawi 6 and KamuzuCentral Hospital, Lilongwe, Malawi
Email: Ellen G Piwoz*  epiwoz@aed.org; Yvonne Owens Ferguson  yvonne_ferguson@unc.edu; Margaret E Bentley  pbentley@unc.edu; Amy L Corneli  amycorneli@aol.com; Agnes Moses  midimoses@yahoo.com; Jacqueline Nkhoma  jacquernkhoma@yahoo.com; Beth Carlton Tohill  bft4@cdc.gov; Beatrice Mtimuni  beatricemtimuni@yahoo.com; Yusuf Ahmed  yaa8@cdc.gov; Denise J Jamieson  djj0@cdc.gov; Charles van der Horst  cvdh@med.unc.edu; Peter Kazembe  pnkazembe@malawi.net; the UNC Project BAN Study Team  epiwoz@aed.org * Corresponding author
Published: 09 March 2006Received: 18 July 2005 Accepted: 09 March 2006 International Breastfeeding Journal2006,1:2 doi:10.1186/1746-4358-1-2 This article is available from: http://www.internationalbreastfeedingjournal.com/content/1/1/2 © 2006Piwoz et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background:To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. Methods:As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Results:Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding. Conclusion:Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.
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